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Cushman DM, Vomer R, Teramoto M, O'Sullivan M, Mulvey J, Eby SF, McAuliffe S. Sonographic Assessment of Asymptomatic Patellar and Achilles Tendons to Predict Future Pain: A Systematic Review and Meta-analysis. Clin J Sport Med 2024:00042752-990000000-00196. [PMID: 38864880 DOI: 10.1097/jsm.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/10/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Patients with clinical tendinopathy often demonstrate significant abnormalities with ultrasound (US) imaging. Tendon abnormalities likely precede pain in these patients. The purpose of this review was to systematically evaluate the available literature regarding the utility of US imaging as a method to predict Achilles and patellar tendon pain. DESIGN Systematic review and meta-analysis. Inclusion criteria were as follows: prospective studies of Achilles and patellar tendon pain development with baseline US measurements, follow-up clinical measurements, and English-language studies published after 2000. Exclusion criteria were prior rupture or surgery and presence of rheumatologic disorder. SETTING N/A. PATIENTS Athletes without Achilles or patellar tendon pain at baseline. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Risk ratios (RRs) were identified for the development of pain in those with Achilles or patellar tendon sonographic abnormalities. RESULTS This review of 16 studies included 810 Achilles and 1156 patellar tendons from a variety of sports and demonstrated that the RR for pain development from abnormal Patellar and Achilles tendons was 6.07 [95% confidence interval (CI), 2.88-12.81; P < 0.001] and 3.96 [95% CI, 2.21-7.09; P < 0.001], respectively. The positive and negative predictive values of an abnormal US finding were 27.2% and 92.0% for the Achilles tendon and 27.2% and 93.5% for the patellar tendon, respectively. CONCLUSIONS This systematic review and meta-analysis identified that the use of asymptomatic US scanning of the Achilles or patellar tendon has a low positive predictive value but a high negative predictive value for the future development of pain.
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Affiliation(s)
- Daniel M Cushman
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Rock Vomer
- Department of Family and Community Health, Division of Sports Medicine, Duke University, Durham, North Carolina
- Department of Orthopedics, Division of Sports Medicine, Duke University, Durham, North Carolina
| | - Masaru Teramoto
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Maddie O'Sullivan
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jade Mulvey
- School of Medicine, University of Utah, Salt Lake City, Utah
| | - Sarah F Eby
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Sean McAuliffe
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
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2
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Cesanelli L, Venckunas T, Ylaitė B, Streckis V, Kamandulis S, Degens H, Satkunskiene D. Discipline-specific Torque-Velocity Profiles and Musculotendinous Morphology in Athletes. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2024; 24:127-138. [PMID: 38825995 PMCID: PMC11145326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES The aim of this study was to compare torque-velocity profiles, muscle architecture, tendon dimensions, and bilateral-symmetry between competitive cyclists (CY), competitive runners (RN), ice-hockey players (IH), basketball players (BP), and physically-active individuals (CN) (n=10 for each group). METHODS Vastus lateralis (VL) muscle and patellar tendon (PT) structures were determined with B-mode ultrasonography, and maximal knee extensor isokinetic torque was assessed at three different velocities. RESULTS Optimal torque and velocity were lower in runners than CY, BP and IH (p<0.05). Maximal power was similar between the athlete groups but greater than CN (p<0.05). Furthermore, RN and BP reached their peak-torque at longer muscle lengths compared to IH and CY (p<0.05). RN had the lowest VL muscle thickness and the greatest fascicle length, while CY had the greatest pennation angle (p<0.05). CY had the greatest PT thickness, particularly at the proximal and medial sites, while BP at the distal point (p<0.05), with similar trends observed for PT cross-sectional-area. CONCLUSIONS Our findings show that even if power generating capacity is similar between athletic disciplines, there are discipline-specific muscle adaptations, where particularly runners appear to have muscles adapted for speed rather than torque development, while in cyclists, velocity is sacrificed for torque development.
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Affiliation(s)
- Leonardo Cesanelli
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Tomas Venckunas
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Berta Ylaitė
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Vytautas Streckis
- Deparment of Coaching Science, Lithuanian Sports University, Kaunas, Lithuania
| | - Sigitas Kamandulis
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Hans Degens
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Danguole Satkunskiene
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
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Romero-Morales C, Berzosa-Rojo Á, Di Luca-Calabrese D, Vázquez-González S, Abuín-Porras V, Jaén-Crespo G, García-Sanz F, Pareja-Galeano H. Comparative analysis of patellar tendon, achilles tendon and plantar fascia structure in indoor and outdoor football players: a novel cross-sectional pilot study. Sci Rep 2024; 14:3930. [PMID: 38365861 PMCID: PMC10873369 DOI: 10.1038/s41598-024-54403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
Different sport modalities were associate with tendon adaptation or even tendon disturbances, such as volleyball, soccer or basketball. Purpose: the aim of the present study was to determine de difference between indoor and outdoor football players on patellar tendon (PT), Achilles tendon (AT), plantar fascia (FP) and Hoffa's fat pad thickness assessed with ultrasound imaging (USI). A cross-sectional study was developed with a total sample of 30 soccer players divided in two groups: outdoor group (n = 15) and indoor group (n = 15). The thickness of PT, AT, PF and Hoffa's fat pad has been assessed with USI. Hoffa's fat pad reported significant differences for the left side between groups (P = 0.026). The rest of variables did not show any significant difference (P < 0.05). The ultrasonography assessment of the thickness of the PT, AT and PF did not show differences between outdoor and indoor football players. Hoffa's fat pad resulted showed a significant decrease for outdoor soccer players with respect futsal players. Thus, it can be considered that the load stimuli received in both soccer players were not enough to produce structural adaptations in PT, AT and PF tissues.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.
| | - Álvaro Berzosa-Rojo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | | | - Sergio Vázquez-González
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Gonzalo Jaén-Crespo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Fernando García-Sanz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Clínica CEMTRO, Madrid, Spain
| | - Helios Pareja-Galeano
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
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Klich S, Michalik K, Rajca J, Ficek K, Fernández-de-Las-Peñas C, Kawczynski A, Madeleine P. Fatigue-induced Alterations of the Patellar Tendon in Elite Sprint Track Cyclists. Int J Sports Med 2023; 44:995-1002. [PMID: 36690028 DOI: 10.1055/a-2018-2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aims to investigate morphological and mechanical properties and echogenicity of the patellar tendon (PT) after acute fatigue-induced alterations in sprint track cyclists. Fourteen elite track cyclists participated in this study. The exercise protocol consisted of three maximal start accelerations (over a distance of 62.5 m), one maximal start acceleration (at both 125 m and 250 m), and sprints from the standing start. Immediately after testing all measurements, PT stiffness and thickness were set at 5-10-15-20 mm distal from the apex of the patella and 5-10 mm proximal to the tibial tuberosity. CSA was set at proximal, middle, and distal, while echogenicity was at proximal and distal points. The results showed significant increases in PT stiffness at all reference points after start acceleration (p<0.001). PT thickness showed similar results for stiffness, except for location placed at TT-5 (p<0.001). CSA increased significantly in proximal, middle, and distal regions (p<0.001), while echogenicity of the tendon increased in proximal and distal regions (p<0.001) after start acceleration. Regional-dependent alterations of PT thickness and stiffness may be related to anatomical and physiological mechanisms due to acute isometric contraction in the initial phase of standing start. Tendon echogenicity might be also useful in monitoring tendon mechanical properties and defining acute fatigue-induced changes.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
| | - Kamil Michalik
- Department of Human Motor Skills, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
| | - Jolanta Rajca
- Department of Science, Innovation and Development, Galen-Orthopaedics, Bieruń, Poland
| | - Krzysztof Ficek
- Department of Physiotherapy, Jerzy Kukuczka Academy of Physical Education In Katowice, Katowice, Poland
- Department of Science, Innovation and Development, Galen-Orthopaedics, Bieruń, Poland
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional En Docencia, Clínica E Investigación En Fisioterapia: Terapia Manual, Punción Seca Y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Adam Kawczynski
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Pascal Madeleine
- Health Science and Technology, Aalborg University, Aalborg, Denmark
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Aguilar-Nuñez D, Cervera-Garvi P, Aguilar-Garcia M, Cuevas-Cervera M, Gonzalez-Muñoz A, Navarro-Ledesma S. Ultrasound Strain Elastography Reliability in the Assessment of the Plantar Fascia and Its Relationship with the Plantar Thickness in Healthy Adults: An Intra and Interobserver Reliability Study in Novice Evaluators. Biomedicines 2023; 11:2040. [PMID: 37509678 PMCID: PMC10377694 DOI: 10.3390/biomedicines11072040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE This study was aimed at verifying both the intraobserver and interobserver reliability of measuring plantar fascia stiffness for a given image in healthy active adults. METHODOLOGY This study is reported following the Guidelines of Reporting Reliability and Agreement Studies. A total of 20 plantar fascia from healthy volunteers were analyzed. The thickness of the plantar fascia was measured vertically from the anterior edge of the inferior calcaneal border to the inferior border of the plantar fascia and the ultrasound elastography measurement was taken at the calcaneal insertion of the plantar fascia with the region of interest one centimeter away from the insertion. RESULTS The ultrasound strain elastography measurements: the right intraobserver 1 showed an ICC value of 0.9 and the left intraobserver 1 showed an ICC value of 0.78, while the right intraobserver 2 showed an ICC value of 0.91 and the left intraobserver 2 showed an ICC value of 0.83. Interobserver measurements showed excellent reliability with a right ICC value of 0.8 and a left ICC value of 0.9 for the plantar fascia thickness measurements. DISCUSSION The results of this study showed a strong correlation between left and right plantar fascia thickness. The intraobserver reliability was excellent for both plantar fascia ultrasound strain elastography and thickness measurements, with interobserver measurements showing excellent reliability.
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Affiliation(s)
- Daniel Aguilar-Nuñez
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Maria Aguilar-Garcia
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
| | - Maria Cuevas-Cervera
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
| | - Ana Gonzalez-Muñoz
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
| | - Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
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da Silva Júnior JEF, Dibai-Filho AV, Santos IS, Protázio JB, Júnior JDA, de Oliveira DD, Dos Santos PG, Fidelis-de-Paula-Gomes CA. Measurement properties of the short version of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) for individuals with knee osteoarthritis. BMC Musculoskelet Disord 2023; 24:574. [PMID: 37452316 PMCID: PMC10347856 DOI: 10.1186/s12891-023-06696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Assessment instruments play an essential role in the management of knee osteoarthritis. This study aimed to verify the clinimetric properties and validate the short version of WOMAC's (SV-WOMAC) knee with two domains, pain (four items) and physical function (eight items) in individuals with knee osteoarthritis (KO). METHODS Reliability and internal consistency Construct, criterion validity, Ceiling, and floor effects analyses were performed. In addition to the SV-WOMAC, the following instruments were used: the numerical rating scale (NRPS), International Knee Documentation Committee (IKDC), the Short Form Health Survey (SF-36), and WOMAC's original version. Spearman's correlation coefficient (rho) was used to determine the magnitude of the correlation between the AFAQ and the other instruments. Moreover, the test-retest reliability and internal consistency were assessed using the intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. In addition, standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. RESULTS One hundred and thirteen subjects with KO were included for validity analysis, and a subsample of 53 subjects was used for test-retest reliability. Adequate reliability and internal consistency were observed with ICC ≥ 0.76, SEM ≤ 1.85, MDC ≥ 5.1, and Cronbach's alpha ≥ 0.84. Regarding construct validity, correlations greater than 0.50 were observed with the IKDC, NRPS, and functional domains of the SF-36. The SV-WOMAC showed a correlation > 0.70 with the original version and did not show ceiling and floor effects. CONCLUSION The SV-WOMAC knee has adequate measurement properties to analyze pain and physical function in Brazilian individuals with KO.
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Affiliation(s)
- José Edson França da Silva Júnior
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Inaê Silva Santos
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Jhonata Botelho Protázio
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - José Djalma Arrais Júnior
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Daniella Dias de Oliveira
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Patrícia Gabrielle Dos Santos
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Cid André Fidelis-de-Paula-Gomes
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, Liberdade, São Paulo, SP, CEP 01504-001, Brazil.
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dos Reis-Junior JR, Bassi-Dibai D, Morais DN, Pontes-Silva A, Mendes LP, Pinheiro JS, Fidelis-de-Paula-Gomes CA, Dibai-Filho AV. Translation, cross-cultural adaptation, and validation of the Athlete Fear Avoidance Questionnaire (AFAQ) into Brazilian Portuguese. BMC Musculoskelet Disord 2022; 23:974. [PMID: 36357871 PMCID: PMC9647760 DOI: 10.1186/s12891-022-05951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
Background Psychological factors play an important role in the adequate return of an athlete to sport. Our aim was to perform the translation, cross-cultural adaptation, and validation of the Athlete Fear Avoidance Questionnaire (AFAQ) into Brazilian Portuguese. Methods We performed the translation and cross-cultural adaptation and evaluated the structural validity, construct validity, and test–retest reliability. In addition to the AFAQ, we used the Numerical Pain Scale (NPS), Pain-Related Catastrophizing Thoughts Scale (PCTS), Self-Estimated Functional Inability because of Pain Questionnaire for athletes (SEFIP-sport), and Hospital Anxiety and Depression Scale (HADS). We used the exploratory factor analysis (EFA) to analyze the internal structure of the AFAQ. We used the Spearman’s correlation coefficient (rho) to determine the magnitude of correlation between the AFAQ and the other instruments. We evaluated the test–retest reliability and internal consistency by means of intraclass correlation coefficient (ICC) and Cronbach’s alpha, respectively. Results No adaptation was necessary to produce the AFAQ version in Brazilian Portuguese. We included 160 participants in the study. We identified the one-dimensionality of the AFAQ through the EFA with the implementation of parallel analysis (KMO = 0.83, p < 0.001 in Bartlett's Sphericity test). In construct validity, the magnitudes of correlation between the AFAQ and the other instruments ranged from 0.257 to 0.548. We identified adequate reliability (ICC = 0.85) and internal consistency (Cronbach’s alpha = 0.90). Conclusion The Brazilian version of the AFAQ with one domain and 10 items has adequate measurement properties in injured professional and recreational athletes. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05951-0.
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